3D Essentials for Artis Zee, Zeego and Q

BEFORE USING THE SYSTEM This system should be used only by employees adequately trained in the use of this equipment. Before using this system, the operator should be thoroughly acquainted with the instructions for use and safety recommendations. Failure to follow the instructions for use and safety recommendations can cause serious injury to the patient, the operator or to other persons. This on-line learning module is not to be used as a substitute for on-site applications training by a Siemens Clinical Education Specialist (CES). Diagnosis based on syngo Workplace images alone are not sufficient. Always use the original scenes on the Artis monitors as a primary image source on which any diagnosis is based. Please note that a reconstruction of 3D data after a recalibration or with future software versions may not be possible.   By the end of this learning module you will be able to: Aquire 3d images Manipulate 3d images Save and store 3d images Inspace 3d and DynaCT are the basic techniques from Siemens to reconstruct a 3D dataset of cross-sectional images from projection images acquired in a 3D acquistion run on the Artis Zee, Zeego and Q. The basic differences between InSpace 3D imaging and DynaCT are as follows: InSpace 3D • Creates a 3D model obtained through a rotational acquisition. • High contrast resolution is desired (Clips, coils, bone, contrast filled vessels). • Reconstructions from 133-266 images, usually acquired in 5 second program. DynaCT • Creates CT-like images obtained through a rotational acquisition. • Low contrast resolution is desired • Reconstructions from 248-800 images or more acquired in 6 to 20 seconds     Acquire - Image Acquistion syngo InSpace 3D and DynaCT have been developed for diagnostic purposes in general and for interventional applications in particular. 3D volume data generated by syngo InSpace 3D and DynaCT allow multidirectional viewing of the reconstructed volume. syngo InSpace 3D and DynaCT data provide an additional image basis for deciding on the therapeutic procedure to be performed immediately after the examination.     For step-by-step instructions on how to perform a DynaCT or InSpace 3D Mechanical Tableside Spin, select the link below. Performing a Mechanical Tableside Spin Performing a Mechanical Tableside Spin Checklist TitleChecklist TypeChecklist ContentStep 1HTML Select the required 3D acquisition program on the touchscreen console.    Step 2HTML Follow the instructions on the data display / Assist screen / message bar.   Step 3HTML  The following message is shown:    Step 4HTML Press the stand joystick down, deflect the joystick and hold it in this position until the C-arm is positioned in the AP/ frontal position.    Step 5HTML Center the region of interest in the image under fluoro.  Step 6HTML    Adjust tabletop longitudinally and transversely.  Step 7HTML  The following message is shown.    Step 8HTML Press the stand joystick down, deflect the joystick and hold it in this position until the C-arm is positioned in the lateral position.  Step 9HTML   Center the region of interest in the image under fluoro by adjusting table height.  Step 10HTML  The following message is shown.    Step 11HTML   Press down the stand joystick and deflect it forward. Hold it in this position until the C-arm reaches the start position  Step 12HTML The following message is shown.    Step 13HTML   Press down the stand joystick and deflect it forward. Hold it in this position until the C-arm stops moving. Note: The 3d test phase is a reduced speed rotation of the C-arm that allows the operator to evaluate possible collision with equipment, personnel, or patient that may lie within the path of the C arm rotation during the full speed acquisition. The test phase may be aborted voluntarily to avoid any possible collisions.  Step 14HTML The following message is shown.    Step 15HTML  Press the FLUORO pedal on the foot switch for approximately 2 seconds.  The following message appears briefly.    Step 16HTML  The following message appears.    Step 17HTML  Instruct the patient to remain still and not to breathe. Press the exposure release button or pedal and keep it pressed until the end of the 3D acquisition (i.e. until the mask phase and fill phase are completed). Upon completion of the acquisition, acquired data is automatically transferred for reconstruction on the XWP. Image transfer can also be done manually (see Secondary Reconstruction). If the exposure release button or pedal is released before the end of the process, the 3D acquisition will be aborted resulting in no image transfer. NOTE: During the mechanical acquisition, the maximum c-arm speed is: • 40°/s in Artis floor and Artis biplane • 60°/s in Artis ceiling and Zeego Collision detection is suppressed during 3D rotational spin.   Application Protocol Book for syngo DynaCT in IR  Contrast Recommendations and Case Studies Application Protocol Book for syngo DynaCT Cardiac   Select individual cover images to launch pdf files of the documents in a separate window. With Artis zee / zeego the primary reconstruction parameters are automatically linked to the exam set used. When the 3D acquisition protocol is selected, the system already knows how to reconstruct the acquired data. Once an image series has been loaded via automatic transfer from the acquisition system, several checks are performed and data is processed using default parameters.During this time, a progress bar is displayed. Then the reconstructed 3D image is displayed. It is possible to change the reconstruction parameters after the automatic transfer. This will be discussed later in this training.     Select the image to view a short demonstration video on manipulating the Orientation subtask card. The task card that displays tools for the MPR and clip planes is singular and is dependent upon the image type selected.  If a VRT image type is active, the Clip Subtask Card is displayed. If an MPR image type is active, the MPR sub task card is displayed. For additional details on other features and options, refer to your syngo workplace manual. Tools Subtask Card contains options for filming and modifying images.   Measure Subtask Card Different measurement methods are provided. Possible to overlay a grid pattern on the 3D image which makes it possible to estimate distances between points in the volume.   In this application the measurement grid (1) allows you to place a measurement grid over a 3d volume. The grid can be panned and rotated to align with anatomic structures. The grid magnication directly corresponds to any zooming done to the 3d image. In order to measure the distance between 2 points on a 2D image (i.e, clip plane), left click the ruler icon (2). In order to measure the distance between 2 points on a 3D image, left click the ruler and protractor icon (3). Right-clicking the ruler/protractor icon gives access to additional measurement options     X-ray Subtask Card Features applications that communicate directly with the Artis imaging systems. To adjust the C-arm position corresponding to image display (Automap) in syngo X Workplace, select the C-arm adjust to 3d image icon (1)   To perform automatic movement on Artis zee/zeego, press the stand joystick (of plane A) down and deflect it forward until the target position is reached To adjust image display corresponding to C-arm position in syngo X Workplace, select the 3d image adjust to C-arm icon (2). The icon will remain activated and the image will follow C-Arm rotation until the icon is deactivated.   When you rotate the image, the C-arm displayed in the top right corner performs the rotation correspondingly. It moves to all positions, although the C-arm may not be able to rotate to that position in reality.  Angulation data is displayed next to the C-arm.   Image 1 Image 1 shows the C-arm and table blue - The C-arm position is reachable  Image 2 Image 2 shows the C-arm red and table blue - The C-arm position is not reachable  Image 3 Image 3 shows the C-arm red and table red - The C-arm position is not reachable and it collides with the patient table.   Select the c-arm datagraphic icon to show or hide the c-arm graphic     Click the Save As icon (1) to create a new series or append the image to an existing one or select the image and click the Save icon (2).  The Save to Database dialog box appears.  Enter an individual name for the new series in the Save images in new series field and confirm with Save. Send to film sheet function is accessible via the Send to Film sheet icon (3).  To bookmark the current image setting: Right-click the Load/Save Series Bookmark icon (4) to save the current settings. Enter a name in the item name field. Make sure that the Bookmark checkbox is enabled. Confirm with Save & Close. To load the bookmark again Left-click the Load/Save Series Bookmark icon (4). Select the bookmark and confirm with Apply. You should now be able to: Aquire 3d images Manipulate 3d images Save and store 3d images Select the link to view a short demonstration video on rotating an image. Video Rotating the Volume   Select the link to view a short demonstration video on zooming and panning. Zooming and Panning Zooming and Panning   Select the link to view a short demonstration video on windowing an image. Windowing Windowing   VOI Punching allows you to manually draw a volume of interest with the cursor and to remove everything within or outside the selection. Select the link below to view a short video on the procedure. VOI Punching VOI Punching   3 different  formats for MPRs: MPR (1) MIP (2) MinIP (3)     MPR displays the image as an average of the Houndsfield values per pixel in a given slice thickness and is most commonly used for soft tissue evaluation.     Select the image to view a short instructional video  on MIP.   Select the image to view a short instructional video on MinIP.   Select the image to view a short instructional video on MPR slice thickness modification.   Select the image to view a short instructional video on the MPR click and scroll through images procedure.   Select the image to view a short instructional video MPR planning lines. Select the link below to view examples of the types of exam sets available specifically for inspace 3D and DynaCT. Note: Dyna CT 360, large volume and certain start positions are unique to the Zeego   Exam Set Selection Learn more about the exam set titles and information about these organ programs. Base ImageHotspotsText BlocksImage File5sDSA Head - Most commonly used neuro application, high contrast subtracted imaging for visualization of aneurysms and AVM’s, can also be reconstructed to include clips and coils post-embolization/surgery.5sDR Head - Not frequently used, Native Acquisition low resolution.5sDR Head Care - low dose 3D acquisition, used only as a fusion registration spin for bony landmarks.20sDCT Head 70kV - High resolution, low contrast imaging acquisition. Results in CT like reconstruction useful for bleeding detection of hemorrhagic stroke patients without the presence of metal ie:clips/coils. Soft Tissue imaging.20sDCT Head 109kV - High resolution, low contrast imaging acquisition. Results in CT like reconstruction useful for bleeding detection of hemorrhagic stroke patients with the presence of metal ie:clips/coils. Soft Tissue imaging.8s/6sDSA DCT Head - High Contrast , High resolution imaging, can be used for dual volume reconstruction of flow diverters.10sDCT Head - Post-flow diverter placement acquisition, High Resolution, Low contrast. Designed to be used with IV injection. Soft Tissue imaging.10s DSA DCT Head - High Contrast, High Resolution imaging for post flow diverter placement. Reconstructed as a Dual Volume.8s/6s Neuro-PBV - Parenchymal Blood Volume Acquisition, used to evaluate the presence of contrast in brain tissue, manually triggered spin.5sDR Body - Not frequently used, Native Acquisition, Low resolution.5sDSA Body - High contrast subtracted imaging for visualization of vessels, ie: splenic artery aneurysms, AVMs, Transplanted Kidney Anastomosis.5sDR Body Care - Low dose 3D acquisition, used only as a fusion registration acquisition for bony landmarks.8s/6sDCT Body - Most commonly used Body Dyna CT acquisition, Low Contrast, High Resolution, Results in a CT like reconstruction for Liver Embolizations, AAA planning, tumor biopsies, etc. Soft Tissue imaging.5sDCT Body Care - A low dose version of the 8s/6sDCT Body, resonable soft tissue imaging.5s Liver-PBV - Parenchymal Blood Volume Acquisition. Used to evaluate the amount of contrast in Liver tissues Pre and Post embolization.5sDR Card - Low Dose version of the 5sDCT Card Acquisition. Primarily used in Pediatric Cardiology.5sDCT Card - Low Contrast, High Resolution Acquisition for Cardiac Procedures. Used in EP to identify and segment the Left Atrium during Ablation procedures.5sDCT Card ECG - ECG triggered Dyna CT, not commonly used.5sDR Card AVG - Low Dose Acquisition for evaluation, planning, and deployment of a percutaneously placed Aortic Valve.5sDCT Card AVG - Used in the evaluation, planning, and deployment of a percutaneously placed Aortic Valve. Patient dropdown menu > Inspace Reconstruction. Select raw data in the patient browser (1)  Click the "Send to 3D" icon (2).  Two image projections (differing by 90°) of a scene representing the acquired 3D raw data are displayed. From the Reconstruction tab you can: Select a preset (1)   Choose the Reconstruction Volume (2)   Select a Reconstructional Kernel (3)   Change Image Characteristics (4)   Change other parameters.  VRT Used to differentiate between organs and tissue structures, and for colored, 3-dimensional display of bone, tissue, and organs.    Typically used for display of high contrast subtracted 3D images. MPR Places the 3D volume into sagittal, coronal, and axial orientations, similar to CT.   Used to display high resolution, low contrast Dyna CT images. Volume Rendering Technique (VRT) Multi-Planar Reformating (MPR) Use presets located in the AX section (1) Presets useful for InSpace 3D / DynaCT / DynaCT Cardiac / Neuro-PBV IR / Liver-PBV IR images (2) Click a preset to apply and confirm with the apply button (3). The window and color settings are now applied to the volume.   Radial Ranges function  Creates a series of images with different view directions. The cut or projection planes of the images are rotated through a pivot of a defined angle.  Select the Radial Ranges icon on the Tools Subtask card. Set the Angle Range, Angle Step and Number of Images (1).  Click the Start button (2) to calculate the image range. Return to the Patient Browser to send/export VRT Collection image(s) to network or CD/DVD Remember to Refresh Browser to see updated VRT Radial Collection image.   Set the range length, image spacing, and the number of images (1).  Confirm each change in the dialog box.  Ensure that your output is set to database (2). This will store your saved images as a series in your local database accessible in your browser.   The image range is now indicated by yellow lines in the active reference image. You can move and rotate the yellow lines in such a way that the image range covers the whole region of interest Cick the Start button (3) to calculate the image range.